2026-2027 Registration

2026-2027 Registration

Complete the registration form using the fields and sections from the DOCX document. Default fields to optional unless the document clearly indicates they are required.
Student and Parent Information
Student Name

First NameMiddle NameLast Name
Grade
Parent Name

First NameMiddle NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Email
example@example.com
Required Documents and Fee Acknowledgements
Immunization Records Attached
Financial Aid Application Submitted
Registration ($150) and Books/Technology Fees ($250) Submitted
Testing Fee for qEEG Brain Scan and Evaluation ($4000) Submitted
Senior Fees for Graduation and Class Trip ($200) Submitted
Program Permissions and Authorization
Local Field Trips – Student Name
Social Media Pictures – Student Name
Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty: